Conditions That May Simulate Fixed Drug Eruption

Early vesicular or bullous lesions on mucous membranes could be confused with a herpetic infection or an early localized stage of pemphigus vulgaris. There should be no confusion with an established FDE once the history of acute onset and cyclical recurrence is elicited.

Figure 2: Common sites of fixed drug eruption.


History Review

A 70-year-old man on multiple medications presents with dusky, asymmetric red plaque lesions first noted upon awakening. The patient complains of a deep burning itch and states he has had identical lesions at the same sites on three previous occasions over the past 2 years. You suspect a fixed drug eruption.

1. What history should be elicited from this patient pertaining to a fixed drug eruption?

Answer: An exhaustive history of prescription and over-the-counter medications, food, and nutritional supplements. Be especially concerned about medications used on an intermittent basis.

2. What other variations in appearance of lesions may characterize fixed drug eruptions?

Answer: Primary lesions may include sharply demarcated pink or dusky violet macules or plaques. Vesicles or bullae may also be present. Secondary lesions may include moist erosions and dusky brown or gray-brown pigmentation that is persistent.

3. What treatment is appropriate for this patient's fixed drug eruption? Answer: Avoidance of the offending substance is essential.

4. What is this patient's prognosis?

Answer: The prognosis is excellent if the offending substance can be found and avoided. If not, the eruption will recur and gradually extend.

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